Epidemiologist/Statistician, Department of Research, UNC Health Sciences at MAHEC, Asheville, North Carolina, United States of America.
Department of Health and Wellness, University of North Carolina Asheville, Asheville, NC, United States of America.
PLoS One. 2022 Aug 17;17(8):e0271755. doi: 10.1371/journal.pone.0271755. eCollection 2022.
People living in rural regions in the United States face more health challenges than their non-rural counterparts which could put them at additional risks during the COVID-19 pandemic. Few studies have examined if rurality is associated with additional mortality risk among those hospitalized for COVID-19. We studied a retrospective cohort of 3,991 people hospitalized with SARS-CoV-2 infections discharged between March 1 and September 30, 2020 in one of 17 hospitals in North Carolina that collaborate as a clinical data research network. Patient demographics, comorbidities, symptoms and laboratory data were examined. Logistic regression was used to evaluate associations of rurality with a composite outcome of death/hospice discharge. Comorbidities were more common in the rural patient population as were the number of comorbidities per patient. Overall, 505 patients died prior to discharge and 63 patients were discharged to hospice. Among rural patients, 16.5% died or were discharged to hospice vs. 13.3% in the urban cohort resulting in greater odds of death/hospice discharge (OR 1.3, 95% CI 1.1, 1.6). This estimate decreased minimally when adjusted for age, sex, race/ethnicity, payer, disease comorbidities, presenting oxygen levels and cytokine levels (adjusted model OR 1.2, 95% CI 1.0, 1.5). This analysis demonstrated a higher COVID-19 mortality risk among rural residents of NC. Implementing policy changes may mitigate such disparities going forward.
美国农村地区的居民面临着比非农村地区居民更多的健康挑战，这可能使他们在 COVID-19 大流行期间面临额外的风险。很少有研究调查农村地区是否与 COVID-19 住院患者的额外死亡风险有关。我们研究了北卡罗来纳州 17 家医院之一的临床数据研究网络合作的 3991 名因 SARS-CoV-2 感染住院并在 2020 年 3 月 1 日至 9 月 30 日期间出院的患者的回顾性队列。检查了患者的人口统计学、合并症、症状和实验室数据。使用逻辑回归评估农村与 COVID-19 住院患者死亡/临终关怀出院复合结局的关联。农村患者的合并症更为常见，每位患者的合并症数量也更多。总体而言，505 名患者在出院前死亡，63 名患者出院到临终关怀。在农村患者中，16.5%死亡或出院到临终关怀，而城市队列中为 13.3%，导致死亡/临终关怀出院的可能性更大（OR 1.3，95%CI 1.1，1.6）。当根据年龄、性别、种族/民族、支付者、疾病合并症、就诊时的氧气水平和细胞因子水平进行调整时，这一估计值略有下降（调整后的模型 OR 1.2，95%CI 1.0，1.5）。这项分析表明，北卡罗来纳州农村居民的 COVID-19 死亡率更高。未来实施政策改革可能会减轻这些差异。
